It's an incredibly complex and emotive issue all round, and there truly aren't any simple answers.

Even 'best interests' is very, very subjective, even if only applied to the person with the DNR, let alone anyone else. It is all 'circumstantial' in my opinion.

For example, when my husband collapsed, quite unexpected and catastrophically, and was taken to hospital the oncologist DNR'd him. I went ballistic, partly out of shock, partly out of fierce, fierce protectiveness of HIM, but ALSO of our son.

My reasoning was, and remains, this - yes, my husband was terminally ill, we knew that, but we also knew that his 'worst' prognosis was about a year, and up to his sudden collapse (caused by his brain tumours worsening dramatically and putting pressure on his brain, hence his collapse) (he was just about unconscious), he'd actually been very 'well' outwardly.

So, in the space of a few hours my son went from 'Dad who appears pretty well, and may outlive his prognosis anyway' to being DNRd was INTENSELY distressing.

My judgement, therefore was, whether or not my husband either wanted not to be resuccitated, or would have a significantly poorer quality of life, eg, even if he went into, say, a coma, the whole purpose of keeping him alive by ANY means was to give my son TIME to accept he was NOW losing his father.

THAT was the 'best interests' I had in mind (it gave ME time too, to make that dreadful adjustment).

In the end, it didn't come to it - but I have always felt I had to get him out of that damn hospital as they would have let him die in front of our eyes without making the slightest attempt to save a man who had fought SO hard to stay alive for his family. It seemed the final insult to just 'let him die' like that.....

So, I give that example to show that DNRs are NOT always the 'best' thing to do, EVEN IF they are 'medically advised' - ie, if the Quality of Life post-resucc would be dire and highly temporary anyway.

And now for a completely opposite example of the complexity of DNRs....

My friend's father, a widower, lived happily in his house, pottering around, but with kidney disease and increasing 'infirmity', and some signs of incipient dementia. He was found, one morning, collapsed on the floor, and rushed into hospital, where it was 'touch and go' for quite some time. He was already well into his eighties, and had pretty advanced kidney disease.

My friend was told they were going to lose him, but she got stuck in and rustled up more consultants etc etc, and in the end he did pull through, but it was, in a way, very much up to her. The hospital would quite happily have 'let nature take its course', given his age, general condition, incipient dementia and, above all, the prospect of dialysis looming.....

OK, so fast forward - FIVE YEARS LATER - the dad is still living with his daughter, in her fifties, and is SEVERELY suffering with advanced dementia. She has endured it for FIVE YEARS of her precious life - he has evaded dialysis but is permanently catheritised, which, combined with dementia makes it VERY hard to care for him.

Yes, she could 'put him in a home' but she took him on, and wants to 'see him out'......

Now, I can look at her situation and think - you know, saving his life back then in hospital was NOT the best idea, after all, was it? You've paid a very heavy price for it. And so, really, has he.

The dementia is awful - this was a man who was an erudite, dignified man, highly qualified with a responsible job, who had had a good long retirement doing research into academic subjects he found fascinating - and now he wanders around the house, a sad and sorry wreck (pitiably, she found him once walking around upstairs with his trousers round his ankles, hobbling along, and no underpants, having tried to adjust his own catherer). I say this GRAPHICALLY to show just how dreadful it is that he is still alive in his condition now.

And I would say the same of my poor, poor MIL. A once independent, scrupulously chic and groomed woman, intelligent and determined and immensely capable, etc etc, and she is now a sad, shrivelled, barely-kempt, vacant-eyed 'ghost' of herself.....

Ditto for my SIL's mother, again, an immensely capable woman, who declined to a self-soiling vacant wreck, utterly pitable and dreadful to see......

My point is - there are times when it is 'better' for THEIR sakes to 'let them go' if the opportunity arises. If their 'real selves' could see themselves now, they would be appalled.....

(I'm sorry if I'm sounding 'hostile' to those with dementia, I'm not in the least, I'm horrified FOR them, not AT them. It's just a dreadful, dreadful affliction, and, to my mind, the ultimate proof that 'life without mental health' is at the very very least, highly questionable in its value....)

Yes, a very emotive topic. My personal decision, because my poor hubby is in the nursing home, as you know, is due to the fact we had discussed it more than once, and he said not to let them do that to him, as he had witnessed it a few times in his line of work. As BB said, it's a subject that needs to be spoken about, however hard. A male visitor, can not bring himself to sign for his wife. I understand that. Depends on beliefs, circumstances and age.

The physical condition of the patient is important. As mum had a severely bent back, the consultant told her that there was a possiblility that they might break it in the process. When I say "severe" she was permanently bent double, it was impossible for her to lie flat.